Hand hygiene observations…not so secret anymore

Abstract

BACKGROUND Tracking hand hygiene compliance (HHC) is an important function in healthcare to monitor compliance and validate accountability. Using a covert approach to monitoring hand hygiene limits the ability to collect a sufficient number of observations that are non-biased and highly reliable. Our objective is to create a program to reduce bias, be more reliable, yield a greater number of observations, and provide real time feedback. METHODS We implemented an overt observation program to collect data and provide real-time feedback to staff at a 900-bed multi-facility academic medical center. Paid overt observers, who wear blue vests, used an electronic survey tool on mobile tablets to collect hand hygiene observations on all staff disciplines entering and exiting patient care areas. Observers had to collect both the entry and exit of the staff member to count as one observation. The observers also gave immediate feedback, both positive acknowledgment and constructive reminders for missed opportunities. Captured in real time, the data was distributed weekly and monthly to unit and discipline leadership. RESULTS The total number of observations from the overt program was 24,598 for fiscal year (FY) 2016 compared to 8,548 covert observations in FY 2015. HHC improved from 68% to 88% from FY 2016 to FY 2017. The increase in HHC was statistically significant using the Chi square test. Verbal feedback given to staff increased from 67% in FY 2017 to 88% in FY 2018. CONCLUSIONS Since overt observers are not unit specific, they are able to provide an unbiased perspective when gathering observations. Assessments of the program are continuous. Observers complete competencies on an established schedule to ensure accuracy and consistency of each observer. With the implementation of the overt program, there was a statistically significant increase in the number of observations collected, improved compliance, and the ability to give and track feedback.